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Combined chloroquine and primaquine resistant Plasmodium vivax malaria in a patient returning from India. 1例从印度返回的间日疟患者对氯喹和伯氨喹联合耐药。
K Van den Abbeele, E Van den Enden, J Van den Ende
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引用次数: 0
Malaria vector control: a critical review on chemical methods and insecticides. 疟疾病媒控制:化学方法和杀虫剂综述。
M Coosemans, P Carnevale
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引用次数: 0
An etiologic study of hemoglobinuria and blackwater fever in the Kivu Mountains, Zaire. 扎伊尔基伍山区血红蛋白尿和黑水热的病因学研究。
C Delacollette, H Taelman, M Wery

Between January 1985 and March 1986, in the high altitude area of Kivu, Eastern Zaïre, 38 patients presenting with hemoglobinuria as main manifestation were investigated. Profound glucose-6-phosphate dehydrogenase deficiency was detected in 4 patients, leptospirosis in 2 and Hantaan virus infection in 2. Hemolysis was doubtful (haptoglobin > 40 mg/dl, Hemoglobin > 12 g/dl) in 2 patients. Other potential causes of hemoglobinuria such as hemoglobinopathy, toxic agents, infectious diseases or blood transfusion incompatibility were carefully screened and excluded. The syndrome observed in the remaining 28 cases was strongly suggestive of blackwater fever (BWF) as described in malaria patients by several authors under the french name "fièvre bilieuse hémoglobinurique". Quinine was used as curative treatment of malaria before admission in a significant greater proportion (p < 0.01) of patients with BWF compared to patients with uncomplicated malaria, suggesting that this drug might have played a triggering role in the genesis of BWF. However, quinine was usually administered at inadequate doses to malaria patients non responding to chloroquine and belonging to a population of whom 50% are non immune. It may thus also be hypothesized that BWF in our patients could result from a hyperparasitemic state that remained undetected because of an unusual synchronous lysis of infected erythrocytes. In the latter case BWF would correspond to a major complication of falciparum malaria only coincidentally related to the use of quinine.

1985年1月至1986年3月,在Zaïre东部基伍高海拔地区调查了38例以血红蛋白尿为主要表现的患者。重度葡萄糖-6-磷酸脱氢酶缺乏症4例,钩端螺旋体病2例,汉滩病毒感染2例。2例患者溶血可疑(接触珠蛋白> 40 mg/dl,血红蛋白> 12 g/dl)。其他可能引起血红蛋白尿的原因,如血红蛋白病、有毒物质、传染病或输血不相容性,都经过仔细筛选和排除。在其余28个病例中观察到的综合症强烈暗示了黑水热(BWF),正如几位以法文“fivre bilieuse hsammoglobinurique”命名的作者在疟疾患者中所描述的那样。入院前使用奎宁治疗BWF患者的比例显著高于无并发症疟疾患者(p < 0.01),提示该药物可能在BWF的发生中发挥了触发作用。然而,对于对氯喹无反应的疟疾患者,通常给予的奎宁剂量不足,并且属于50%无免疫力的人群。因此,我们也可以假设,我们患者的BWF可能是由于感染红细胞不寻常的同步溶解而未被检测到的高寄生虫状态所致。在后一种情况下,BWF相当于恶性疟疾的一种主要并发症,只是碰巧与使用奎宁有关。
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引用次数: 0
[Plasmodium falciparum index and level of parasitemia: diagnostic and prognostic value in the Congo]. [恶性疟原虫指数和寄生虫血症水平:刚果的诊断和预后价值]。
B Carme, M P Hayette, A Mbitsi, H Moudzeo, J C Bouquety

Parasitological data of various malarial studies performed in the Congo where Plasmodium falciparum malaria is holo-endemic in rural and suburban zones, between 1988 and 1991, were analyzed with the intention of establishing diagnosis and prognosis value of Plasmodium falciparum parasitaemia in areas with high perennial transmission. In such an area congolese school-children (6-10 years old) had 88% P. falciparum index, this is the same percentage as that for children hospitalized with a pernicious attack. However, the parasite load is distributed differently; parasitaemia is greater than 6,000 asexual form of P. falciparum/microliters (afPf/microL) in only 4.6% of cases in the former group versus 67% in the second group. A threshold of 10,000 afPf/microliters, above which the Plasmodium infection triggers a febrile attack in semi-immune children, is confirmed in school children in a rural context where the factor of taking antimalarial drugs within the preceding days is negligible; three out of four children with levels above this threshold are febrile versus 4.1% (7 out of 170) with lower blood parasite levels. Some adults were also asymptomatic carriers but much less frequently and with lower mean parasitaemia levels. The parasite load mirrors the clinical severity although this concept can be misleading as an individual prognostic criterion and for hospital studies carried out in areas where multiple drug administration before hospitalisation is common. For the studies recently performed in Brazzaville, the 5% threshold level of parasitized red cells, the WHO severity criterion, was never reached in asymptomatic subject or in cases of simple attack; it was reached in one out of two cases of pernicious attack.

本文分析了1988年至1991年在刚果(金)农村和郊区恶性疟原虫全流行地区开展的各种疟疾研究的寄生虫学数据,目的是确定恶性疟原虫寄生虫病在常年高传播地区的诊断和预后价值。在这一地区,刚果学龄儿童(6-10岁)的恶性疟原虫指数为88%,这与因恶性感染而住院的儿童的百分比相同。然而,寄生虫负荷分布不同;在前一组中,只有4.6%的病例中恶性疟原虫的无性形式大于6000 /微升(afPf/microL),而在第二组中,这一比例为67%。在农村地区的学龄儿童中,在前几天内服用抗疟药物的因素可以忽略不计的情况下,确认了1万afPf/微升的阈值,超过这个阈值,疟原虫感染就会在半免疫儿童中引发发热发作;血液寄生虫水平高于这一阈值的儿童中有四分之三出现发热,而血液寄生虫水平较低的儿童中有4.1%(170名儿童中有7名)出现发热。一些成年人也是无症状携带者,但频率低得多,平均寄生虫血症水平较低。寄生虫负荷反映了临床严重程度,尽管这一概念作为个人预后标准和在住院前使用多种药物的地区进行的医院研究可能会产生误导。对于最近在布拉柴维尔进行的研究,在无症状受试者或单纯发作病例中,从未达到世卫组织严重程度标准——寄生红细胞5%的阈值水平;两例恶性攻击中就有一例达到这一水平。
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引用次数: 0
Alternative application of melarsoprol for treatment of T. B. gambiense sleeping sickness. Preliminary results. 美拉胂醇在治疗冈比亚锥虫昏睡病中的替代应用。初步结果。
C Burri, J Blum, R Brun

The protocols for treatment of human African trypanosomiasis (sleeping sickness) with the organoarsenical drug melarsoprol are based on empirical observations. Therapy is often accompanied by serious side effects and relapses. Additionally, the duration of treatment, which is up to forty days, is a major drawback in African countries. Based on pharmacokinetic investigations an alternative therapy protocol for T. gambiense sleeping sickness has recently been proposed which consists of ten consecutive injections of 2.2 mg/kg melarsoprol given at intervals of 24 hours. In a preliminary study, eleven patients were treated in Vanga, Zaire following this alternative protocol which reduces the duration of the treatment to ten days. The results indicate that the alternative schedule was as effective as the traditional protocol, showed similar adverse reactions but required a much shorter treatment period.

使用有机砷药物美拉胂醇治疗非洲人类锥虫病(昏睡病)的方案是基于经验观察。治疗往往伴随着严重的副作用和复发。此外,治疗时间长达40天,这是非洲国家的一个主要缺点。根据药代动力学研究,最近提出了一种治疗冈比亚锥虫昏睡病的替代治疗方案,即每隔24小时连续注射10次2.2 mg/kg的美拉胂醇。在一项初步研究中,11名病人在扎伊尔万加接受了这一替代性方案的治疗,该方案将治疗时间缩短至10天。结果表明,替代方案与传统方案一样有效,出现相似的不良反应,但所需的治疗时间要短得多。
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引用次数: 0
[Role of education in the development of health systems]. [教育在卫生系统发展中的作用]。
P Mercenier
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引用次数: 0
Roles of the general practitioner in different contexts. 全科医生在不同情况下的角色。
M Van Dormael

The word ¿general practice¿ denotes different contents of work as we look at different contexts. General practitioners may provide first line care, function as secondary care providers at hospital level, take responsibility for the management of health care systems. These different roles can be seen as results from historical processes of division of work in the field of health care, which gave general practice its present shapes. During the first half of the 20th century, western general practitioners were gradually excluded from hospitals as well as from public health activities. When they started to react in order to increase their legitimacy they strived--with variable success--to gain recognition as curative first line care providers, as this had become the only place in the health care system they could claim for. They gradually defined their specificity in terms of polyvalence enabling them to deal with unselected problems, and in terms of global view allowing for adequate priority setting. In developing countries, the organisation of medical care was and remains influenced by western models. As in western countries, emphasis has been put on specialisation and hospital technology. General practice was not exported to developing countries: general practitioners appear rather as cheap substitutes for specialists. The most typical workplace for general practitioners in developing countries remains the rural hospital. But their role model refers to the hospital based specialist: they tend to focus on patient care for hospital users rather than on dynamising health care delivery to the whole community in the district. In urban areas, the recent expansion of (mostly private) first line medical care is also not specific to general practice and tends to be in favour of specialists. What is the common denominator to these different roles, if any? A possible answer lies in the primary health care approach. It allows to define the specificity of general practitioners in terms of multifactorial approach and global view on health and illness, which differentiates them from specialists. Whether they provide this care themselves or organise it at district level could be less important to their professional identity than the general attitudes and knowledge they rely on.

“一般实践”一词在不同的语境下表示不同的工作内容。全科医生可能提供第一线护理,在医院一级作为二级保健提供者,承担卫生保健系统的管理责任。这些不同的作用可以看作是卫生保健领域分工的历史进程的结果,这一进程赋予了全科医生目前的形式。在20世纪上半叶,西方全科医生逐渐被排除在医院和公共卫生活动之外。当他们开始为增加自己的合法性而做出反应时,他们努力——取得了不同程度的成功——获得了作为治疗第一线护理提供者的认可,因为这已经成为他们在医疗保健系统中唯一可以要求的地方。它们逐渐从多效性方面确定了它们的特殊性,使它们能够处理未选择的问题,并从全局的角度考虑适当的优先事项。在发展中国家,医疗保健的组织过去和现在都受到西方模式的影响。与西方国家一样,重点放在专业化和医院技术上。全科医生没有输出到发展中国家:全科医生似乎更像是专家的廉价替代品。发展中国家全科医生最典型的工作场所仍然是农村医院。但他们的榜样指的是以医院为基础的专科医生:他们倾向于关注医院用户的病人护理,而不是为整个地区的社区提供卫生保健服务。在城市地区,最近扩大的一线医疗保健(主要是私人的)也不是专门针对全科医生,而且往往有利于专科医生。如果有的话,这些不同角色的共同点是什么?一个可能的答案在于初级卫生保健方法。它允许在多因素方法和对健康和疾病的全球观点方面定义全科医生的特殊性,这将他们与专家区分开来。对于他们的职业身份而言,他们是自己提供这种护理还是在地区一级组织这种护理可能不如他们所依赖的一般态度和知识重要。
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引用次数: 0
Clinical training for tropical doctors in the nineties. 九十年代热带医生的临床培训。
J Van den Ende, W Van Damme, A Van Gompel, E Van den Enden

Together with economic causes, the declining belief in the relevance of clinical skills, the omission of the hospital from the health system, and the erroneous generalisation of a complaint centred approach enhanced the decline in clinical medicine in several developing countries over the last decades. Despite a growing interest and important efforts in continuous education, basic training remains generally knowledge-directed. Clinical training should start from a realistic job description, and aim at acquiring skills instead of knowledge. Basics of clinical epidemiology can help refine clinical logic both at the health centre and the hospital level. the district hospital should be awarded a key role in pre-graduate and continuous clinical training. Awaiting a revival of the economy in most tropical countries, and especially in tropical Africa, an effective way for improving clinical practice is to invest in training, at all levels, with an emphasis on continuous medical training.

加上经济原因,对临床技能相关性的信任度下降,医院被排除在卫生系统之外,以及错误地推广以投诉为中心的方法,这些都加剧了过去几十年来几个发展中国家临床医学的衰落。尽管人们对继续教育越来越感兴趣并作出了重要努力,但基本培训总体上仍以知识为导向。临床培训应该从现实的工作描述出发,以获得技能而不是知识为目标。临床流行病学的基础知识可以帮助改善卫生中心和医院层面的临床逻辑。地区医院应在研究生预科和继续临床培训中发挥关键作用。在大多数热带国家,特别是热带非洲国家的经济复苏之前,改善临床实践的一个有效办法是投资于各级培训,重点是持续的医疗培训。
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引用次数: 0
[What to expect of an improvement in education of general practitioners in developing countries?]. [对发展中国家全科医生教育的改善有何期待?]
J P Unger
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引用次数: 0
[Apprenticeship in adult education. The case of education of general practitioners]. 成人教育中的学徒制。[全科医生的教育]。
A Buron, J P Unger, W Van Damme
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引用次数: 0
期刊
Annales de la Societe belge de medecine tropicale
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